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General NPI Number Information
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NPI Number | 1154750537
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Entity Type | Individual
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Provider Name | SANDY HERNANDEZ BCBA
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Gender | Female
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 2155 CHICAGO AVE STE 203
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City | RIVERSIDE
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State | CA
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Zip | 92507-2209
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Country | US
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Telephone | 310-493-2228
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Fax |
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Provider Business Mailing Address
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Address Line | 6713 IRON HORSE LN
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City | EASTVALE
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State | CA
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Zip | 92880-9128
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-14689
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License Number State | CA
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